Schedule for Immunization of Preterm Infants

All Preterm Infants

• Vaccine doses should not be reduced for preterm infants.

• Use thimerosal-free vaccines.

• Intramuscular injections to preterm infants might require a shorter needle than the standard 5/8 to 1” needle.

• Immunizations may be given during corticosteroid administration.

• Palivizumab (synagis) should be given according to the respiratory syncytial virus policy.

• Preterm infants should receive a full dose of diphtheria and tetanus toxoids and acellular pertussis (DTaP), Haemophilus influenza type B (Hib) conjugate, inactivated poliovirus (IPV), hepatitis B (Hep B), and pneumococcal conjugate (PCV13) at 60 days’ chronologic age, regardless of birth weight and gestational age, as long as they are medically stable and consistently gaining weight. These should be repeated in another 60 days.

• Immunizations for preterm infants may be given over 2 or 3 days to minimize the number of injections at a single time.

• Hospitalized infants with birth weight lower than 1000 g should be observed for apnea for 72 hours after the primary series of immunizations. The CBC may show a left shift and the CRP may be elevated.

• Breastfeeding by a mother who is positive for hepatitis B surface antigen (HBsAg) poses no additional risk for acquisition of hepatitis B virus (HBV) infection by the infant.

• Infants with chronic respiratory tract disease should receive the influenza inactivated trivalent or quadrivalent immunization annually, before or during the influenza season, when they are 6 months’ postnatal age or older:

  • Infants who are 6 months to 8 years of age who have not previously received two doses of the influenza vaccine should receive two doses of vaccine at least 28 days apart.

  • Family and other caregivers should also receive the inactivated trivalent or quadrivalent influenza vaccine annually in the fall to protect the infant from exposure.

• The American Academy of Pediatrics recommends routine immunization of infants in the United States with rotavirus vaccine. There is no preference for either the live oral human-bovine reassortant vaccine (RV5) or the live oral, human attenuated rotavirus vaccine (RV1).

• Preterm infants who are clinically stable should be immunized for rotavirus on the same schedule and with the same precautions as term infants. The infant's postnatal age must be between 6 weeks and 14 weeks, 6 days postnatal age. Rotarix is a two-dose series, at 2 and 4 months of age. RotaTeq is a three-dose series, at 2, 4, and 6 months of age. If any dose is RotaTeq or an unknown product, three doses should be given.

• Preterm infants who are in the NICU or nursery may be immunized at the time of discharge if they are clinically stable and age-eligible for the vaccine. The AAP believes that the risk of shedding vaccine virus in the stool, and theoretically transmitting vaccine virus to another acutely ill or non-age-eligible infant, if the infant is readmitted, is less than the benefit of immunizing eligible infants.

• Any rotavirus vaccine-immunized infant who requires readmission to the NICU or nursery within 2 weeks of vaccination should remain under contact precautions for 2-3 weeks after vaccine administration.